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Spinal Injuries - Principles

Complications of spinal injury

  • Neurological damage

  • Damage to vertebral column causing deformity and pain

Stable injuries

  • Vertebral components won't be displaced by normal movement.

  • An undamaged spinal cord is not in danger

  • There is no development of incapacitating deformity or pain

Unstable injuries

  • Further displacement of the injury may occur

  • Loss of 50% of vertebral height

  • Angulation of thoracolumbar junction of > 20 degrees

  • Failure of at least 2 of Denis's 3 columns

  • Compression # of three sequential vertebrae can lead to posttraumatic kyphosis

Anatomical considerations

  • The upper thoracic spine (T1-T10) is protected by the ribs, sternum and the facet joint orientation

  • At the thoracolumbar junction there is a fulcrum of increased motion, so there is increased risk of injury

  • The middle thoracic spine is a vascular 'watershed', vascular insult can cause cord ischaemia

    (Artery of Adamkiewitz)

  • Cauda equina begins at L1-L2. Lesions below L1 have a better prognosis as nerve roots, not cord are affected

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